Anesth Pain Med.  2018 Jul;13(3):319-322. 10.17085/apm.2018.13.3.319.

Suspected abdominal compartment syndrome during endoscopic diskectomy: A case report

• Park J
• Lim HK
• Choi JH
• Choi WJ
• Lee J
• Lee KH

• KMID: 2436042
• DOI: http://doi.org/10.17085/apm.2018.13.3.319

Abstract

Abdominal compartment syndrome can produce a critical situation if not diagnosed early and managed properly. We report a case of abdominal compartment syndrome that was caused by massive irrigation of surgical fluid during endoscopic lumbar diskectomy at the L4-L5 level. There was a sudden increase in peak inspiratory pressure during the operation, and the patient's tidal volume and blood pressure decreased. When the patient's position was changed from prone to supine, abdominal distension and cyanosis of both lower extremities were discovered. Ultrasonic findings showed fluid collection in both the chest and intra-abdominal cavity. Thoracentesis and abdominal decompression surgery were performed, and the patient's overall state improved. We concluded that irrigation fluid used during the endoscopic operation leaked into the retroperitoneal space and caused abdominal compartment syndrome.

Keyword

Abdominal compartment syndrome; Diskectomy; Endoscopy

MeSH Terms

Blood Pressure
Cyanosis
Diskectomy*
Endoscopy
Intra-Abdominal Hypertension*
Lower Body Negative Pressure
Lower Extremity
Retroperitoneal Space
Thoracentesis
Thorax
Tidal Volume
Ultrasonics

Figure

• 

  Fig. 1 Chest radiograph. (A) Preoperative chest X-ray (posteroanterior view) shows normal. (B) Chest X-ray (anteroposterior view) shows haziness in both lung field 30 minutes after the increase in airway pressure.

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  Fig. 2 (A) Ultrasonographic image at the right posterior axillary line around the lower tip of the scapula. Fluid collection of 2.8 cm width was observed in the pleural cavity (arrow). (B) Ultrasonographic image at the right middle axillary line around the lower tip of the scapula. Fluid collection of 2 cm width was observed in the right upper quadrant of the abdominal cavity (arrow head).

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